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What is Holding You Back from an EHR
Revolution?
Session PE4, February 11, 2019
Taylor Davis, VP of Innovation, KLAS
Christopher Sharp, CMIO, Stanford Health Care
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Taylor Davis, KLAS
Manages the KLAS Arch Collaborative and is an employee of KLAS.
Christopher Sharp, Stanford University School of Medicine
Has no conflicts of interest.
Conflict of Interest
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• Impact and scope of burnout on medicine
• Framework for combatting burnout
• How the EHR impacts burnout (and visa versa)
• Variation drivers in EHR success
• Framework for EHR success
Agenda
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• Inspect the learnings of both the Stanford WellMD and KLAS Arch
Collaborative research efforts to understand the common
principles that lead to decreased physician burnout and greater
EHR success.
• Review specific case studies of successful provider organizations
who have created greater EHR mastery in their EHR users,
connecting this greater mastery to better clinician fulfillment.
• Debunk many of the common myths that organizations have
regrading creating EHR success and decreasing burnout.
• Review a checklist that organizations can use to measure their
own EHR success readiness and progress towards decreased
burnout.
Learning Objectives
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What’s Happening to Doctors?
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Burnout is a syndrome of depersonalization,
emotional exhaustion, and low personal
accomplishment that leads to decreased
effectiveness at work.
What is Burnout?
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Burnout by Specialty 2011
N=7288
Shanafelt et al, JAMA Int Med 172:1137
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Burnout in the U.S.: Physicians &
Population
Shanafelt TD et al. Mayo Clinic Proceedings. 2015 90:1600
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Stanford Physician Well-Being
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Trockel and colleagues 2017
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Well Physicians = Higher Performance
Physicians Who are Well:
‒ Higher patient satisfaction (Beach, et al. 2013)
‒ More likely to support preventive health
practices in patients (Duperly, et al., 2009; Frank, et
al., 2008; Frank, et al. 2013)
‒ Lower medical error rate (Fahrenkoph, et al. 2008;
Shanfelt, et al. 2010; West, et al. 2006)
‒ Better patient outcomes, e.g.
decreased post-hospital discharge
recovery times (Halbesleben and Rathert, 2008)
‒ Less likely to leave their organization
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What is the value ($$) of wellness?
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The Business Case for Investing in Physician Well-being. Shanafelt T, Goh J, Sinsky C.
JAMA Intern Med. 2017 Dec 01;177(12):1826-1832.
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Lower
Costs
Improved
Patient
Care
Clinician
Well-being
Better
Outcomes
Achieving our mission is no longer possible
without addressing wellness
Fourth
Aim
Bodenheimer, Ann Fam Med 12:573
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Aiming for Professional Fulfillment
Bohman, NEJM Catalyst 2016
Leadership
Values Alignment
Voice/input
Meaning in work
Community/collegialit
y
Peer Support
Appreciation
Flexibility
Culture compassion
EHR usability
Triage
Scheduling
Patient portal
Documentation
method
Team-based care
OR turnaround
times
Staffing
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What is the role of health information
technology?
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How the EHR Contributes to Burnout
Toll, E. The Cost of Technology. JAMA.
2012;307(23):2497-2498.
Usability /
User
Interface
Built-in
Regulatory &
Documentation
Requirements
Effect on
Interpersonal
Interactions
Shift in
Workload to
Providers
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It’s About Time
• For every hour physicians provide direct clinical face time,
nearly 2 additional hours is spent on EHR and desk work
• EHR time while face-to-face is equal to “Desktop Medicine”
(patient messages, refills, ordering tests, reviewing results)
• While in the room with patients, physicians spent ~50% on
direct clinical face time and ~40% on EHR and desk work
Sinsky C, et al. Allocation of physician time in ambulatory practice: a time
and motion study in 4 specialties. Ann Intern Med. 2016;165:753-60.
Tai-Seale M, et al. Electronic Health Record Logs Indicate That Physicians
Split Time Evenly. Health Aff (Millwood). 2017 Apr 01;36(4):655-662.
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My Internal Medicine Clinic
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Minutes per Day (Unscheduled Days)
Minutes per Day (7pm-7am Activity on Scheduled Days)
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Ambulatory Physician
Optimization Program
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Participation
Offered to 600+ providers with 84% participation
94% of participants are “likely to recommend”
Includes faculty and community physicians
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Matthew Hiller
Mona Sidhu
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2%
15%
19%
17%
34%
32%
80%
51%
49%
Impacts
4%
25%
30%
24%
46%
38%
72%
29%
32%
Initial Survey Data - Satisfaction
(N=343)
Post 30 Day Follow-up Survey - Satisfaction
(N=86)
Satisfaction with EHR
Proficiency Using EHR
Initial Survey Data - Competence
(N=343)
Post 30 Day Follow-up Survey - Competence
(N=86)
Excellent / Very Good
Good
Poor / Fair
Satisfaction with Clinical Work
Initial Survey Data – Clinical Satisfaction
(N=101)
Post 30 Day Follow-up Survey – Clinical Satisfaction
(N=101)
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Looking forward
Usability /
User
Interface
Regulatory &
Documentation
Requirements
Enhanced
Interpersonal
Interactions
Team-based
Care
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Key Finding:
The EHR is often
perceived as a driver of
burnout.
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Click to edit Master title style
Burnout vs. Net EHR Experience Score
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167 organizations
Over 70,000 clinical responses
Same EHR questions . . .
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Do you agree that
your EHR enables
you to deliver high-
quality care?
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Where Does the Variation Come
From?
© Copyright KLAS 2019
From the EHR
Vendor?
From the
Provider Organization?
From the
Clinician Users?
Engage Deeper With
Individual Clinicians
Improve EHR
Development
Improve
Implementation
& Configuration
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© Copyright KLAS 2019
60%
18%
22%
Where Does the Variation Come
From?
From the
EHR Vendor?
From the
Provider
Organization?
From the
Clinician
Users?
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73% of organizations have two
physicians
of the same specialty
using the same EHR
One physician
STRONGLY DISAGREES
the EHR enables them to
deliver high-quality
healthcare.
One physician
STRONGLY AGREES
the EHR enables them to
deliver high-quality
healthcare.
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© Copyright KLAS 2019
You have reported high satisfaction. What
do you believe you do differently from some
of your peers that enables you to be highly
successful with the EHR?
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© Copyright KLAS 2019
KLAS Team Favorite Answer:
“I am smarter than they are.”
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© Copyright KLAS 2019
Second Favorite Answer
“Maybe lower expectations?”
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What Makes a Successful EHR User?
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© Copyright KLAS 2019
Initial Training vs. EHR Experience
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© Copyright KLAS 2019
Personalization Adoption vs. EHR
Experience
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Organization Trust vs. EHR
Experience
© Copyright KLAS 2018
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Case Study: OrthoVirginia Sees Huge Satisfaction Improvement
